Airway-clearance therapy guidelines and implementation

Abstract

The clearance of secretions from the lungs of patients with cystic fibrosis (CF) is an important component in the fight to preserve their lung function. There is excessive inflammation in the airways of these patients, which is thought to be exaggerated by ineffective mucociliary clearance and bacterial infection. In 2005 the Cystic Fibrosis Foundation formed the Pulmonary Therapies Committee to review all of the medical literature on the various airway-clearance therapies used in treating CF lung disease. The recommendations were: an airway-clearance therapy should be performed by all patients with CF, no form of airway-clearance therapy stood out as being superior to another, and that patients may express a preference of one therapy over another. They also concluded that aerobic exercise is beneficial to patients with CF, as it is to everyone, and that exercise should be a component to the overall health routine of patients with CF. The challenge for respiratory and physical therapists together with the patient/family is to develop a plan of attack through the use of various airway-clearance therapies. The respiratory and physical therapists are integral in helping patients and families develop airway-clearance routines that aid in the removal of the secretions that cause airway obstruction. There is a wide range of airway-clearance therapies that therapists can choose from when they are teaching the patients and family members the strategies of secretion removal. The questions are: What therapy is best for what age or stage of lung disease? What therapies will the patient do? And which therapies will be covered by medical insurance? These are all fundamental questions that must be answered when guiding families in finding therapies that are effective and appropriate for each CF patient's unique situation.